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June 3, 1974

American Cutaneous Leishmaniasis: Inefficacy of Metronidazole in Treatment

Author Affiliations

From the US Army Medical Research Unit, Panama (Walter Reed Army Institute of Research), Balboa Heights, Canal Zone (COL Walton), the Medical Service, Gorgas Hospital, Ancon, Canal Zone (Dr. Paulson), the Sanidad Militár, Guardia Nacional, Panama (Dr. Arjona), and the Medical Clinic, Gamboa, Canal Zone (Dr. Peterson).

JAMA. 1974;228(10):1256-1258. doi:10.1001/jama.1974.03230350028021

American leishmaniasis, a disease limited to the American tropics and relatively unfamiliar to North American physicians, is seen in the United States with increasing frequency since the advent of air travel. In contrast to a recent report of successful treatment with metronidazole, our experience of failure in five of six cases indicates that this drug is ineffective. Unlike Leishmania tropica, which causes the Old World form of cutaneous leishmaniasis, L braziliensis can persist after disappearance of the primary ulcer and subsequently produce severely mutilating mucosal lesions. Because of this danger, complete eradication of the parasite is extremely important and, in spite of recognized disadvantages, pentavalent antimonial compounds remain the drugs of choice for this infection.

(JAMA 228:1256-1258, 1974)